I want to have more respect for my body than that, which is also why I want to value it by minimizing any attempts to permanently change or alter it. Sure, I like lipstick and clip-on hair as much as the next gal, but when it comes to plastic surgery, I can do without it. And finally, I want to drown out the noise from fashion magazines, advertisements, and Hollywood, and hone in on the feedback that my body gives me and respond accordingly with nutrition, rest, and exercise. Admittedly, the last goal has been the most challenging one for me to adhere to, and I am far away from mastering it, but I think as a whole, most people would see the worth in following those principles. It just seems kinda…healthy, right?
Before you answer that, I should point out that it’s a vague question. For a word that dominates so many national and global conversations, the definition of health is hazy, at best. What does it really mean to be healthy in America today? My BMI number is off the charts, well into the “morbidly obese” range, but my blood pressure and my A1C are normal. Am I healthy? My belly fat could scream “unhealthy!” but a snapshot of my exercise habits would suggest the opposite. I have PCOS, which has no cure, but the symptoms can be managed. And, if I am not healthy, who is? Is it the person whose BMI falls into an optimal range? But what if that person smokes? Is he or she still healthy? What about the thin person who lives a sedentary lifestyle and drinks soda every day? Is he or she healthy? How about a person who is only slightly chubby but has sky-high stress levels? The further you go, the blurrier the picture of health becomes.
The dictionary definition of health is: the condition of being well or free from disease; the condition of being sound in body, mind, or spirit. But we tend to emphasize the physical body when we talk about health, forcing other components like mental and emotional health to take a backseat. And we like to interpret health as an absence of undesirable things (heart disease, diabetes, cancer), as opposed to the presence of desirable things (flexibility, endurance, self-confidence). Even though I can’t define health any more clearly than the average person, I do know, after my thirty-two years on this Earth, that several things are true: (1) the BMI is bullshit and, therefore, we cannot use size as a fail-proof determinant of health; (2) weight loss is not a simple equation of calories in versus calories out; and (3) the pursuit of physical health should not happen at the expense of mental or emotional health.
I entered into a relationship with the BMI scale before I was even aware it existed—remember the doctor who asked my mother to restrict my ice cream and chocolate milk intake? He gave this directive after assessing my BMI. During my teenage years, I referred to the BMI to evaluate exactly how fat I really was, and it told me in an uncomplicated way. All I had to do in that pre-Internet era was find my height on the left side of the chart and then slide my finger to match up with my weight at the top. And just like finding your panty-hose size, colored blocks told me which BMI classification I fit into.
So on the night of my prom, my height of five-two and weight of 145 pounds equaled a BMI of 26.5. The classification: overweight. The recommendation: I would benefit from finding ways to lower my weight, like diet and exercise. What the BMI scale didn’t ask me to enter was, well, everything else. Had the BMI scale cared to know, I would have told it that I exercised an average of three hours daily, that I regularly consumed fewer than 2,000 calories per day, and that I passed all the fitness tests in my gym class with flying colors. If I’d known then what I know now, my eighteen-year-old self would have looked the BMI recommendation in the face and said, “Thank you, but no thank you. I’m good.” Then I would have put on my tiara and prom princess sash and sauntered right out of the room.
Because what I know now is that the BMI is an unreliable metric of health. No, really, it is, and there’s evidence to back this up. First of all, the BMI can’t distinguish how much of a person’s weight is body fat and how much is muscle and how much is water. This is easy enough to understand, especially in the case of bodybuilders, for example, who are clearly physically fit but get lumped into the “overweight” or “obese” BMI category simply because of their muscles. But a recent study shows that problems with BMI classifications don’t stop there—not by a long shot. Obesity researchers examined forty thousand people and uncovered that 29 percent of obese people and 16 percent of morbidly obese people were metabolically healthy; that is to say, they were not at risk for type 2 diabetes or heart disease. On the flip side, the study also examined people who were considered in the “normal” weight range and found that thirty percent of them were metabolically unhealthy, meaning they were at risk for type 2 diabetes and heart disease. Overall, the data estimates that a staggering 74.9 million Americans are misclassified in some way because their BMI number doesn’t match up with their metabolic health.*1 This research completely dismantles the “thin = healthy/fat = unhealthy” construct that is so deeply ingrained in our collective psyche, and if this study had needed photographs to illustrate its points, my best friend, Heather, and I would have made perfect models.
For more than ten years while I was fat, I was in good metabolic health, but in March 2015, when I got a prediabetes diagnosis with an A1C level of 6.4, I felt like I was finally proving negative stereotypes about fat people true (added bonus: I got to do it on national TV!). I was disappointed in myself and fearful about the very real possibility of developing type 2 diabetes. However, Heather was also diagnosed with prediabetes at the same time, but for some reason her diagnosis didn’t feel like a moral failing—not to her or anyone else. Because Heather is skinny, she wasn’t racked with the same kind of guilt over developing a metabolic health problem the way I did, and others didn’t vilify her for it the same way they did me, either. Meanwhile, I braced myself for a torrent of “See, I told you so’s” and similar statements echoing the belief that I’d been lying to myself for all this time and now the day had come: I was fat, and fat meant unhealthy.
It was almost as if fat-shamers rejoiced in my health scare, but all of them were silent when Heather ranted on Facebook about how she couldn’t take her low-carb diet one more day and posted a photo of a heaping plate of pasta with the caption #AngelHairDontCare. When I saw that post, I thought two things: (1) Damn, that pasta looks good, and (2) I could never get away with posting this because I’m actually fat. I was too afraid to even show my solidarity by liking the post! Luckily, both Heather and I have managed to lower our A1C levels back down to a healthy range, but in another plot twist, I was able to do it in three months (much faster than Heather), and I lost only seventeen pounds in the process, which flies in the face of another widely held belief: that fat people my size must lose hundreds of pounds to see any tangible improvement in their health.
When I posted about my lowered A1C status on social media the night that the doctor’s visit episode aired (the same night I was in South Africa and Lennie was defending me at the bar), I expected to receive some Internet high-fives and thumbs-up emojis. What I didn’t expect was what actually happened: thousands of people who were incensed that I had the gall to share my test results that proved, according to the standards we use to measure metabolic health, that I was simultaneously over 350 pounds and…healthy. No one could handle seeing a woman as big as me in a doctor’s office being told that my blood pressure was normal and I was out of the woods when it came to prediabetes. No one could handle it because it contradicts what we want to believe about the relationship between weight and health. I was accused of manipulating the test results, but even those who believed me were chomping at the bit to remind me that even if I was healthy now, I wouldn’t be later, and announcing my “healthy” test results was irresponsible because it led people to think that someone my size could have healthy test results. But wait—someone my size did have healthy test results. There is absolutely nothing that is misleading or deceptive about that. But more than the hateful skepticism of strangers, I was most bothered by my own need to defend myself. I thought about scanning the results and posting them or asking the do
ctor to let me take a video of the results in her computer system. Why did I have an insatiable desire to prove that I was healthy?
Even before I readily volunteered my life up for public consumption on a reality TV show, I still wanted to be lumped in with the “good fatties.” Good fatties are fat people who show remorse for their bodies and who actively strive to correct them. They Instagram pictures of their green juice and their spinach salads and participate in 5Ks out of guilt, instead of pleasure. Bad fatties, on the other hand, are the ones who spend much less time apologizing for—and more time living in—their fat bodies. They don’t deem it necessary to wear a Fitbit to demonstrate to others that they keep track of their steps; they just wear a damn Fitbit if they want to. They don’t think they owe their health to anyone. Bad fatties are the ones who don’t “dress for their bodies”; the ones who don’t have any health conditions that contribute to their weight (and they don’t care); and the ones who don’t take any shit. Truth be told, I exercise because I love to exercise. We should all feel free to do whatever we love, regardless of the size of our bodies. But I don’t want to be a “good fatty”; I don’t want to tailor what I do and don’t do based on satisfying other people. I signed a contract that requires me to share intimate details of my personal life and my health, but I try to release the need for others’ approval. Most days, this is easier said than done, but I’m okay with being a work in progress.
One step toward disregarding public approval of my weight is to ignore the BMI scale. Treating the BMI as gospel when it comes to weight and health is bad for all involved. Had the BMI not confirmed the sentiment conveyed in the “Baby Beluga” song from fifth grade, maybe I never would have developed such a bad body image to begin with; I can’t be sure, of course, but I certainly could have done without an arbitrary measurement reinforcing the ideas that young girls struggle with enough on their own. And as it stands, the BMI is still the conclusive way for health insurance companies to figure out how to offer financial discounts or penalties to policyholders, for employers to offer incentives and rewards based on BMI-assessed weight loss, and how doctors diagnose people as overweight or obese. (By the way, the American Medical Association now officially recognizes obesity as a disease, even though the association’s council on science and public health disagreed, for the exact reason that the BMI as a diagnostic tool is simplistic and flawed.)*2
Even if we could accurately diagnose obesity as a disease with a quick and easy tool and then prescribe weight loss as treatment, how would we go about helping people institute that in their daily lives? As long as I’ve been alive, the advice for weight loss has consisted of two main tenets: eat less and exercise more. This may seem like sound advice on the surface, but we are doing people a disservice if we lead them to believe that weight loss is the inevitable result of an equation as straightforward as calories in versus calories out, plus 30 minutes of exercise.
First of all, focusing only on calories consumed and calories burned tells us nothing about what kind of calories they are. All calories are not created equal. Two hundred calories from soda and 200 calories from vegetables are not the same thing because the human body is a complex system that regulates energy balance through different processes, and different calorie sources have different effects on hunger, hormones, and energy expenditure.*3 My dietician, Julie, urges me to stop calorie counting and start listening to my body. Women who have insulin resistance (a lovely side effect of PCOS) don’t process carbs like people whose bodies regulate insulin properly. This is why women with PCOS are told to eat foods that are low in the glycemic index (low GI)—these foods help prevent insulin spikes. When Julie first introduced me to this idea, she asked me to listen to my body and think about how I felt after I ate a carb-heavy meal (like fettuccine Alfredo, for example). When I took her advice and became receptive to my body, I found that my favorite foods left me feeling sluggish and sleepy. No calorie counting or moral judgment about “bad food” was required for me to realize the benefit of trading refined carbs for protein more often than not. I don’t have to say “pasta la vista” to Italian restaurants; I just need to pay attention to how they make me feel and order accordingly.
The takeaway: PCOS complicates more for me than can be fixed by simply counting calories, and to believe in a diet myth like “weight loss is calories in, calories out” completely dismisses the presence of diseases and disorders (think Cushing’s syndrome, thyroid disorders, and Hashimoto’s disease) that play a huge role in how our bodies gain and lose weight. If weight loss depended solely on the amount of calories consumed and the amount of exercise completed, I would have lost 300 pounds back in 2011, not 100. And none of us would have that friend who eats junk, never exercises, and stays rail thin. Weight loss, just like our bodies, is not as simple as we are made to believe.
Now, don’t get me wrong; I have made a concerted effort to stop allowing numbers on a scale to run (and ruin) my life, but I don’t think weight loss is inherently evil. I think where we get it wrong so much of the time is that we’ve convinced ourselves that weight loss is a behavior, but let’s get it straight: weight loss is NOT a behavior. A behavior is opting for a high-protein meal instead of a carb-heavy one. A behavior is loading up a dinner plate with vegetables or taking a walk around the block to get your blood flowing and your heart rate up. We can control behaviors, but as I know all too well, we can’t control weight loss the same way. We can’t just snap our fingers and demand that the scale reflect the five miles we ran or the liter of water we drank. The problem is that we think we can, so when the scale doesn’t give you a gold star in the form of a lower number, we all completely lose our shit. I’m totally for engaging in behaviors that make you feel good, but I cannot, and will never again, support weight loss at all costs or weight loss at the expense of mental and emotional health.
When I was on my weight-loss kick, my eating disorder (bulimia) returned, and I’m sure that wasn’t the only form of disordered eating I would have been diagnosed with at the time. Eating disorders are a mental illness, and anorexia has the highest mortality rate of any mental illness. No matter how much emphasis we place on the scale, I could never look at photos of myself then and now and decide I was healthier before. Yes, in 2011, I weighed only 229 pounds, but I was in the grip of an eating disorder as well as depression and anxiety. Now, I am over 350 pounds, but I am so much more emotionally and mentally well, which in the big picture is so much more important to me. A smaller body means nothing to me if I am mentally or emotionally sick—my goal is to strive for balance in all three areas.
The reason that I, like so many others, was readily willing to sacrifice my mental and emotional health for the sake of being thin(ner) is in no small part due to weight stigma and fat-shaming. I know, I know, not everyone believes that fat-shaming is a thing, but, trust me, it is a thing, and we are finding out now more than ever just how harmful weight stigma is to those who experience it. The Journal of Health Psychology found that obese women experience an average of three incidents of stigmatization each day.*4 So, what do these experiences look like? They can be experiences that happen between people socially, like when I am ridiculed on an online dating site and called a “whale” (BTW, I really wish people would get more creative with their insults). It can happen in the workplace, too. Fat people are assumed to be lazy and lacking in willpower; these undesirable qualities can in turn prevent fat people from getting jobs or promotions. In the medical field, many fat people experience such severe weight stigma that they never want to go back to the doctor, period. This can be annoying (but mostly benign), like a doctor in Korea who swore my weight was a contributing factor to my earache, or it can be much worse; healthcare professionals frequently misdiagnose, mistreat, and sometimes straight up deny medical treatment to fat people.
In September 2015, I responded to an online video titled Dear Fat People with my own video (which has more than 17.7 million views on Facebook). In the original video, a woman claims that “
fat-shaming isn’t a thing” and suggests that if making people feel bad enough about their weight encourages them to lose some, then she’s “okay with that.” But studies show over and over that making people feel bad about their weight has the opposite effect: it causes them to gain more weight.*5 Nothing will send a fatty for the bottom of an ice cream bowl faster than demoralizing them on the basis of their body size. I’m half kidding, but it’s true—fat people who are made to feel bad about their weight are more likely to avoid the doctor (guilty, from ages eighteen to twenty-two, coincidentally when I began gaining weight) and less likely to engage in healthy habits. This is exactly why I started Big Girl Dance Class (where you don’t have to be big in body, just big in spirit). What I had was tons of local girls who loved to dance but didn’t feel like they had a safe space to do it. One of my BGDC members is actually a girl I danced with in high school, and even though she’s a dance teacher now by profession, she was so embarrassed about her weight gain that she refused to dance in any other class or in public. It’s the same thing I suffered through in college when I had an outright fear of going to the gym, especially after one of my trainers spent the whole time I was on the treadmill critiquing the butt of the girl in front of me, saying, “Man, she shouldn’t be wearing those shorts!” I could only imagine what he was thinking about me. The fear of being ostracized is what kept me in my darkened apartment, drinking alone and ordering pizza. And gaining more weight.
I Do It with the Lights On Page 21